CPAN Pharmacology Fundamentals 2 — Questions and Answers
Question 1: A patient in the PACU receives neostigmine to reverse neuromuscular blockade. Which drug must be given concurrently to prevent bradycardia?
- Atropine (Correct answer)
- Epinephrine
- Dopamine
- Phenylephrine
Correct answer: Atropine
Neostigmine inhibits acetylcholinesterase and increases muscarinic activity, requiring concurrent anticholinergic agents like atropine or glycopyrrolate to prevent bradycardia.
Question 2: Which opioid is considered safest in patients with renal failure due to its lack of active metabolites?
- Morphine
- Meperidine
- Fentanyl (Correct answer)
- Hydromorphone
Correct answer: Fentanyl
Fentanyl is metabolized to inactive compounds and does not accumulate in renal failure, unlike morphine (morphine-6-glucuronide) or meperidine (normeperidine).
Question 3: A PACU patient develops laryngospasm. After jaw thrust fails, what drug is the first-line pharmacologic intervention?
- Succinylcholine 0.1–0.2 mg/kg IV (Correct answer)
- Vecuronium 0.1 mg/kg IV
- Propofol 1 mg/kg IV
- Ketamine 0.5 mg/kg IV
Correct answer: Succinylcholine 0.1–0.2 mg/kg IV
A small 'laryngospasm dose' of succinylcholine (0.1–0.2 mg/kg IV) rapidly relaxes the spastic laryngeal muscles while minimizing full paralysis.
Question 4: Dexmedetomidine exerts its sedative and analgesic effects primarily through which receptor?
- Alpha-2 adrenergic receptor (Correct answer)
- GABA-A receptor
- Mu opioid receptor
- NMDA receptor
Correct answer: Alpha-2 adrenergic receptor
Dexmedetomidine is a highly selective alpha-2 adrenergic agonist that produces sedation, analgesia, and anxiolysis with minimal respiratory depression.
Question 5: A patient is receiving ketorolac (Toradol) in the PACU. Which condition is a contraindication to its use?
- Mild hypertension
- Peptic ulcer disease (Correct answer)
- Mild obesity
- Type 2 diabetes
Correct answer: Peptic ulcer disease
Ketorolac is an NSAID that inhibits prostaglandins, increasing the risk of GI bleeding and ulceration, making active peptic ulcer disease a contraindication.
Question 6: Which reversal agent is used to antagonize the effects of benzodiazepines in the PACU?
- Naloxone
- Sugammadex
- Flumazenil (Correct answer)
- Physostigmine
Correct answer: Flumazenil
Flumazenil competitively antagonizes benzodiazepines at GABA-A receptors; its short duration (30–60 min) means resedation is possible.
Question 7: A patient who received a long-acting opioid during surgery receives naloxone in the PACU. What is the most important nursing concern after administration?
- Hypertension crisis
- Resedation and respiratory depression recurrence (Correct answer)
- Prolonged analgesia
- Urinary retention
Correct answer: Resedation and respiratory depression recurrence
Naloxone has a shorter half-life (30–90 min) than most opioids, so resedation and respiratory depression can recur once it wears off, requiring close monitoring.
CPAN Pharmacology Fundamentals 2
A patient in the PACU receives neostigmine to reverse neuromuscular blockade.
Which drug must be given concurrently to prevent bradycardia?